It is estimated that in the United States over 500,000 children are in foster care and another 200,000 receive residential treatment services. Many of these out-of-home placement children have severe emotional and behavioral impairments, with psychotropic medication often playing an important role in their treatment. Pediatric psychopharmacotherapy research, while essential and growing, has been relatively limited in its scope and does not answer the research needs presented by actual day-to- day practice for this highly vulnerable population. A high percentage of youth in out-of- home care are on medications, with many of the medications being off-label and polypharmacy being common. Off-label medications and polypharmacy are both linked to increased adverse effect risk in children. Many researchers have argued that the empirical evidence available is not adequate to fully understand and support the current level of psychotropic prescribing for youth. The proposed scientific meeting will allow experts in out-of-home pharmacotherapy to form collaborations and plan research that will inform practice and policy. The meeting will have three specific aims: (1) To identify promising strategies for avoiding excessive and inappropriate use of psychotropic medications in the treatment of youth with behavioral and emotional problems;(2) To promote collaborative research alliances between basic and applied researchers that will extend beyond the scientific meeting;and (3) To produce a long- term plan for federally-funded studies to research and improve pharmacotherapy practice for youth in out-of-home care. The meeting will occur over a two-day period, with 24 participants coming from both university and provider organizations. All participants will be experienced with current pharmacotherapeutic research and practice in out-of-home treatment settings. The meeting will be held at Boys Town, Nebraska. It is anticipated that this meeting will result in (1) a website being created to facilitate research and advance related public policy efforts in this area, (2) several related collaborative manuscripts within the overall strategy laying the groundwork necessary for successful future NIMH research grant applications, and ultimately, (3) inter-agency collaborative research proposals that will be submitted to the NIMH. PUBLIC HEALTH RELEVANCE: It is critical that behaviorally and emotionally troubled youth in out-of-home settings receive appropriate psychopharmacological care. The goal is for youth to receive the medications they need and no more, in order to maximize the therapeutic benefit and minimize the potential for adverse costs and consequences. To achieve this goal, this meeting will identify promising strategies for avoiding excessive and inappropriate use of psychotropic medications in the treatment of youth with behavioral and emotional problems.